fort monroe

SOUT

MDCPDS...a new system for a new

millenium

System Authorization Access Request

(DISA Form 41)

• MDCPDS is the Database of Record for Civilian
employees.

• Use of DISA Form 41, has required information to
comply with systems security regulations.

• Upon Completion of this form by the CPACs they
should be sent to the SECPOC, Information Services
Division, Functional Automation Branch.

1

USER COMPLETES PART I of DISA Form 41

SYSTBVI AI.JTH0RIZAT10N ACCESS REQUEST (S AAR}

FR'JCT/CT STATMNT

Public Lav 99-474, cbe Couniecfeic Acoeaa Device and Compuiec Fcaud and Abme Accof 1934, auebocizea colleccioaaf ebb i nfn rrm rinn Tbe infoccmcioa v ill
be LDcd id vecify ctm you ace an authorized mec of a Gove come ui aucoimied infocimcion aya cem ( AIS) and/oc id vecify youc level of Gove come or aecucicy
cLea cance. Although dbcLoauee of cbc infocimcion ia volucuacy, failupe id peovide cbc infoumcioa imy impede oc peeve oi cbc pcoccaaiqg of youc "Syaiem
Aucbocizacion Acoeaa Pequeac (SAAP)". DbcLoauee of ccocda oc cbc infocimcion comaincd cbeceinimy be apecifically diacloaed ouiaide cbc DoD accocmqg id
cbe "Blaakec Poucine Uaea" aec foeeb at [be beginnic^ of cbe DISA compilation of aya Dens of cecocda, gublbbed annually in cbe Fedecal Pegbiec, and cbe
dbcloaucea gene tally peemined unde c 5 U.S.C. 552a(b) of cbe Privacy Act.

TVPECFREUET

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FA FT I (To be compleied by User}

1. (LAST, Fra, MF}

2 SODASEUFfYNLIYEBl

2 CnfflMZATKW

4. OTCESvTVBOJDGWnWE^T

CMD/UIC/ORG

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N/A

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STATEvE'C OF AODDLUT^EJ UTY

I unde □land my obligation co pcoiecc my paaavoed.
authorized acoeaa.

LEfflSIGNffl'LRE

I aaaume cbe cea pom i bilicy foe daia and aya Demi amgcanced acoeaa do. I vill one exceed my

D^

2

irt II - to be completed by User's Security Manager (ISSO/TASO)
inimum requirement is a NACI for access to Modem DCPDS and

CSU Regional Reporting Database

FERTII (fobs mpieied k Vsr 1 s Secmy Mumpr j

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3

Part III - to be completed by User's Supervisor and CPAC PSM

MODE

1 1

F£KT 1 1 1 (To be compieied by User ‘ j Supervisor)

15 ADCESREURED (Lxaion) - i.e DMCor DMC's

RN DCPDS /CSU Reaional Renortina Database located at (You

ir Installation Name!

16 ArBSTOO/ffilRajBElIBKP

H N° □ *

17 TYPECFUEffl

\J£ RJMcricm. Q systhvi

sbdjttyjAem rjsnw cr

^PPUO^CWDBfl.CPffL
£J1 -ffi (Specify)

IS JL£HRWTlCNFCRtf]CES

\£H H WT1QN0F l-EEDTO KNIW

I certify ikm cbis me: ccquiccs access as Dcqucsied iacbe pecfoamace of bis/bcc jobfuaccLoo.

19 SI (JJ^TLFECFSLPEFMSCFl

Employee's Supervisor

29 sia^ii^cFRiocr^raAa^mfcm

CPAC

2D. CRG/EEFT.

». CRG/CEFT.

PSM /designated Alternate

21. R-tNENUIYEffl

25 PKJJENUVm

22 CW IE

25 DtfTE

4

PART IV - To be completed by CPOC Systems staff

F£KT IV (To be completed by AlSSe curity Sicff adding user)

27. LEB1D (Mdtframe)

Modern DCPDS Userid C

2& LEEHD (Mid-Tier)

:SU-Regional Reporting DB

23 LSBFID (Network)

Metaframe client Userid

30. SIQWLFE

31. PH3NENJVER

32 DtflE

[1$AFoim41 SEP 1996 jEF)

5

'ART V - to be completed by CPAC PSM or designated alternate

FAFiT V (Cdti be customized by DISA or Customer with DISA appro i-al (Optional))

(To be completed by User)

33L ACCESS FE'CLESTED (Site specific system or application itfiormation)

a S’vSTE WE)

b La-WNG)

Modern Defense Civilian Personnel Data System

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HP N-class (Modern DCPDS)

HP K-460 (CSU Regional Reporting Database
Metaframe server -application access

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Modern DCPDS

CSU Regional Reporting Database

Resumix (CPOC Only)

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Thus"

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6